Comparison of clinician diagnosis of COVID-19 with real time polymerase chain reaction in an adult-representative population in Sweden

Eman Quraishi; Chiamaka Jibuaku; Daniil Lisik; Göran Wennergren; Jan Lötvall; Fredrik Nyberg; Linda Ekerljung; Madeleine Rådinger; Hannu Kankaanranta; Bright I. Nwaru

doi:10.1186/s12931-023-02315-7

Comparison of clinician diagnosis of COVID-19 with real time polymerase chain reaction in an adult-representative population in Sweden

Eman Quraishi
, Chiamaka Jibuaku
, Daniil Lisik
, Göran Wennergren
, Jan Lötvall
, Fredrik Nyberg
, Linda Ekerljung
, Madeleine Rådinger
, Hannu Kankaanranta
, Bright I. Nwaru^*

^*Corresponding author for this work

Seinäjoen keskussairaala VA

Research output: Contribution to journal › Article › Scientific › peer-review

2 Citations (Scopus)

20 Downloads (Pure)

Abstract

Background: Due to the high transmissibility of SARS-CoV-2, accurate diagnosis is essential for effective infection control, but the gold standard, real-time reverse transcriptase-polymerase chain reaction (RT-PCR), is costly, slow, and test capacity has at times been insufficient. We compared the accuracy of clinician diagnosis of COVID-19 against RT-PCR in a general adult population. Methods: COVID-19 diagnosis data by 30th September 2021 for participants in an ongoing population-based cohort study of adults in Western Sweden were retrieved from registers, based on positive RT-PCR and clinician diagnosis using recommended ICD-10 codes. We calculated accuracy measures of clinician diagnosis using RT-PCR as reference for all subjects and stratified by age, gender, BMI, and comorbidity collected pre-COVID-19. Results: Of 42,621 subjects, 3,936 (9.2%) and 5705 (13.4%) had had COVID-19 identified by RT-PCR and clinician diagnosis, respectively. Sensitivity and specificity of clinician diagnosis against RT-PCR were 78% (95%CI 77–80%) and 93% (95%CI 93–93%), respectively. Positive predictive value (PPV) was 54% (95%CI 53–55%), while negative predictive value (NPV) was 98% (95%CI 98–98%) and Youden’s index 71% (95%CI 70–72%). These estimates were similar between men and women, across age groups, BMI categories, and between patients with and without asthma. However, while specificity, NPV, and Youden’s index were similar between patients with and without chronic obstructive pulmonary disease (COPD), sensitivity was slightly higher in patients with (84% [95%CI 74–90%]) than those without (78% [95%CI 77–79%]) COPD. Conclusions: The accuracy of clinician diagnosis for COVID-19 is adequate, regardless of gender, age, BMI, and asthma, and thus can be used for screening purposes to supplement RT-PCR.

Original language	English
Article number	10
Number of pages	14
Journal	Respiratory Research
Volume	24
DOIs	https://doi.org/10.1186/s12931-023-02315-7
Publication status	Published - Jan 2023
Publication type	A1 Journal article-refereed

Funding

We thank the participants for their involvement in the study. We also thank Helén Törnqvist, Helen Friberg, Lina Rönnebjerg, Louise Olausson, and Maryanne Raneklint at Krefting Research Centre for data collection. Open access funding provided by University of Gothenburg. The study was supported by funding from the VBG Group Herman Krefting Foundation on Asthma and Allergy. Additional funding was received from the Swedish Research Council, the Swedish Heart–Lung Foundation, the Swedish Asthma and Allergy Foundation, and ALF agreement (Västra Götaland) (Grants from the Swedish state under the agreement between the Swedish Government and the county councils). BIN acknowledges the support of the Knut and Alice Wallenberg Foundation, and the Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Asthma
Clinical diagnosis
COPD
COVID-19
ICD-10
Negative predictive value
Positive predictive value
RT-PCR
Sensitivity
Specificity
Validation
Youden index

Publication forum classification

Publication forum level 2

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine

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10.1186/s12931-023-02315-7Licence: CC BY

s12931-023-02315-7Final published version, 970 KBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202303243118Licence: CC BY

Cite this

@article{167f93477f8245f9b5229cd69af66523,

title = "Comparison of clinician diagnosis of COVID-19 with real time polymerase chain reaction in an adult-representative population in Sweden",

abstract = "Background: Due to the high transmissibility of SARS-CoV-2, accurate diagnosis is essential for effective infection control, but the gold standard, real-time reverse transcriptase-polymerase chain reaction (RT-PCR), is costly, slow, and test capacity has at times been insufficient. We compared the accuracy of clinician diagnosis of COVID-19 against RT-PCR in a general adult population. Methods: COVID-19 diagnosis data by 30th September 2021 for participants in an ongoing population-based cohort study of adults in Western Sweden were retrieved from registers, based on positive RT-PCR and clinician diagnosis using recommended ICD-10 codes. We calculated accuracy measures of clinician diagnosis using RT-PCR as reference for all subjects and stratified by age, gender, BMI, and comorbidity collected pre-COVID-19. Results: Of 42,621 subjects, 3,936 (9.2\%) and 5705 (13.4\%) had had COVID-19 identified by RT-PCR and clinician diagnosis, respectively. Sensitivity and specificity of clinician diagnosis against RT-PCR were 78\% (95\%CI 77–80\%) and 93\% (95\%CI 93–93\%), respectively. Positive predictive value (PPV) was 54\% (95\%CI 53–55\%), while negative predictive value (NPV) was 98\% (95\%CI 98–98\%) and Youden{\textquoteright}s index 71\% (95\%CI 70–72\%). These estimates were similar between men and women, across age groups, BMI categories, and between patients with and without asthma. However, while specificity, NPV, and Youden{\textquoteright}s index were similar between patients with and without chronic obstructive pulmonary disease (COPD), sensitivity was slightly higher in patients with (84\% [95\%CI 74–90\%]) than those without (78\% [95\%CI 77–79\%]) COPD. Conclusions: The accuracy of clinician diagnosis for COVID-19 is adequate, regardless of gender, age, BMI, and asthma, and thus can be used for screening purposes to supplement RT-PCR.",

keywords = "Asthma, Clinical diagnosis, COPD, COVID-19, ICD-10, Negative predictive value, Positive predictive value, RT-PCR, Sensitivity, Specificity, Validation, Youden index",

author = "Eman Quraishi and Chiamaka Jibuaku and Daniil Lisik and G{\"o}ran Wennergren and Jan L{\"o}tvall and Fredrik Nyberg and Linda Ekerljung and Madeleine R{\aa}dinger and Hannu Kankaanranta and Nwaru, \{Bright I.\}",

note = "Funding Information: We thank the participants for their involvement in the study. We also thank Hel{\'e}n T{\"o}rnqvist, Helen Friberg, Lina R{\"o}nnebjerg, Louise Olausson, and Maryanne Raneklint at Krefting Research Centre for data collection. Funding Information: Open access funding provided by University of Gothenburg. The study was supported by funding from the VBG Group Herman Krefting Foundation on Asthma and Allergy. Additional funding was received from the Swedish Research Council, the Swedish Heart–Lung Foundation, the Swedish Asthma and Allergy Foundation, and ALF agreement (V{\"a}stra G{\"o}taland) (Grants from the Swedish state under the agreement between the Swedish Government and the county councils). BIN acknowledges the support of the Knut and Alice Wallenberg Foundation, and the Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = jan,

doi = "10.1186/s12931-023-02315-7",

language = "English",

volume = "24",

journal = "Respiratory Research",

issn = "1465-9921",

publisher = "BioMed Central",

}

TY - JOUR

T1 - Comparison of clinician diagnosis of COVID-19 with real time polymerase chain reaction in an adult-representative population in Sweden

AU - Quraishi, Eman

AU - Jibuaku, Chiamaka

AU - Lisik, Daniil

AU - Wennergren, Göran

AU - Lötvall, Jan

AU - Nyberg, Fredrik

AU - Ekerljung, Linda

AU - Rådinger, Madeleine

AU - Kankaanranta, Hannu

AU - Nwaru, Bright I.

N1 - Funding Information: We thank the participants for their involvement in the study. We also thank Helén Törnqvist, Helen Friberg, Lina Rönnebjerg, Louise Olausson, and Maryanne Raneklint at Krefting Research Centre for data collection. Funding Information: Open access funding provided by University of Gothenburg. The study was supported by funding from the VBG Group Herman Krefting Foundation on Asthma and Allergy. Additional funding was received from the Swedish Research Council, the Swedish Heart–Lung Foundation, the Swedish Asthma and Allergy Foundation, and ALF agreement (Västra Götaland) (Grants from the Swedish state under the agreement between the Swedish Government and the county councils). BIN acknowledges the support of the Knut and Alice Wallenberg Foundation, and the Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2023, The Author(s).

PY - 2023/1

Y1 - 2023/1

N2 - Background: Due to the high transmissibility of SARS-CoV-2, accurate diagnosis is essential for effective infection control, but the gold standard, real-time reverse transcriptase-polymerase chain reaction (RT-PCR), is costly, slow, and test capacity has at times been insufficient. We compared the accuracy of clinician diagnosis of COVID-19 against RT-PCR in a general adult population. Methods: COVID-19 diagnosis data by 30th September 2021 for participants in an ongoing population-based cohort study of adults in Western Sweden were retrieved from registers, based on positive RT-PCR and clinician diagnosis using recommended ICD-10 codes. We calculated accuracy measures of clinician diagnosis using RT-PCR as reference for all subjects and stratified by age, gender, BMI, and comorbidity collected pre-COVID-19. Results: Of 42,621 subjects, 3,936 (9.2%) and 5705 (13.4%) had had COVID-19 identified by RT-PCR and clinician diagnosis, respectively. Sensitivity and specificity of clinician diagnosis against RT-PCR were 78% (95%CI 77–80%) and 93% (95%CI 93–93%), respectively. Positive predictive value (PPV) was 54% (95%CI 53–55%), while negative predictive value (NPV) was 98% (95%CI 98–98%) and Youden’s index 71% (95%CI 70–72%). These estimates were similar between men and women, across age groups, BMI categories, and between patients with and without asthma. However, while specificity, NPV, and Youden’s index were similar between patients with and without chronic obstructive pulmonary disease (COPD), sensitivity was slightly higher in patients with (84% [95%CI 74–90%]) than those without (78% [95%CI 77–79%]) COPD. Conclusions: The accuracy of clinician diagnosis for COVID-19 is adequate, regardless of gender, age, BMI, and asthma, and thus can be used for screening purposes to supplement RT-PCR.

AB - Background: Due to the high transmissibility of SARS-CoV-2, accurate diagnosis is essential for effective infection control, but the gold standard, real-time reverse transcriptase-polymerase chain reaction (RT-PCR), is costly, slow, and test capacity has at times been insufficient. We compared the accuracy of clinician diagnosis of COVID-19 against RT-PCR in a general adult population. Methods: COVID-19 diagnosis data by 30th September 2021 for participants in an ongoing population-based cohort study of adults in Western Sweden were retrieved from registers, based on positive RT-PCR and clinician diagnosis using recommended ICD-10 codes. We calculated accuracy measures of clinician diagnosis using RT-PCR as reference for all subjects and stratified by age, gender, BMI, and comorbidity collected pre-COVID-19. Results: Of 42,621 subjects, 3,936 (9.2%) and 5705 (13.4%) had had COVID-19 identified by RT-PCR and clinician diagnosis, respectively. Sensitivity and specificity of clinician diagnosis against RT-PCR were 78% (95%CI 77–80%) and 93% (95%CI 93–93%), respectively. Positive predictive value (PPV) was 54% (95%CI 53–55%), while negative predictive value (NPV) was 98% (95%CI 98–98%) and Youden’s index 71% (95%CI 70–72%). These estimates were similar between men and women, across age groups, BMI categories, and between patients with and without asthma. However, while specificity, NPV, and Youden’s index were similar between patients with and without chronic obstructive pulmonary disease (COPD), sensitivity was slightly higher in patients with (84% [95%CI 74–90%]) than those without (78% [95%CI 77–79%]) COPD. Conclusions: The accuracy of clinician diagnosis for COVID-19 is adequate, regardless of gender, age, BMI, and asthma, and thus can be used for screening purposes to supplement RT-PCR.

KW - Asthma

KW - Clinical diagnosis

KW - COPD

KW - COVID-19

KW - ICD-10

KW - Negative predictive value

KW - Positive predictive value

KW - RT-PCR

KW - Sensitivity

KW - Specificity

KW - Validation

KW - Youden index

U2 - 10.1186/s12931-023-02315-7

DO - 10.1186/s12931-023-02315-7

M3 - Article

C2 - 36631852

AN - SCOPUS:85146128125

SN - 1465-9921

VL - 24

JO - Respiratory Research

JF - Respiratory Research

M1 - 10

ER -

Comparison of clinician diagnosis of COVID-19 with real time polymerase chain reaction in an adult-representative population in Sweden

Abstract

Funding

UN SDGs

Keywords

Publication forum classification

ASJC Scopus subject areas

Access to Document

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Cite this